title: Reducing mortality in acute kidney injury patients: systematic review and international web-based survey.
abstract: OBJECTIVE
  To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.
  
  
  METHODS
  Systematic literature review and international web-based survey.
  
  
  METHODS
  More than 300 physicians from 62 countries.
  
  
  METHODS
  Several databases, including MEDLINE/PubMed, were searched with no time limits (updated February 14, 2012) to identify all the drugs/techniques/strategies that fulfilled all the following criteria: (a) published in a peer-reviewed journal, (b) dealing with critically ill adult patients with or at risk for acute kidney injury, and (c) reporting a statistically significant reduction or increase in mortality.
  
  
  RESULTS
  Of the 18 identified interventions, 15 reduced mortality and 3 increased mortality. Perioperative hemodynamic optimization, albumin in cirrhotic patients, terlipressin for hepatorenal syndrome type 1, human immunoglobulin, peri-angiography hemofiltration, fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased intensity of renal replacement therapy (RRT), CVVH in severely burned patients, vasopressin in septic shock, furosemide by continuous infusion, citrate in continuous RRT, N-acetylcysteine, continuous and early RRT might reduce mortality in critically ill patients with or at risk for AKI; positive fluid balance, hydroxyethyl starch and loop diuretics might increase mortality in critically ill patients with or at risk for AKI. Web-based opinion differed from consensus opinion for 30% of interventions and self-reported practice for 3 interventions.
  
  
  CONCLUSIONS
  The authors identified all interventions with at least 1 study suggesting a significant effect on mortality in patients with or at risk of AKI and found that there is discordance between participant stated beliefs and actual practice regarding these topics.
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors.forename: Giovanni
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authors.lastname: Landoni
authors.forename: Tiziana
authors.initials: T
authors.lastname: Bove
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
authors.forename: Marco
authors.initials: M
authors.lastname: Comis
authors.forename: Reitze N
authors.initials: RN
authors.lastname: Rodseth
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasero
authors.forename: Martin
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authors.lastname: Ponschab
authors.forename: Marta
authors.initials: M
authors.lastname: Mucchetti
authors.forename: Tiziana
authors.initials: T
authors.lastname: Bove
authors.forename: Maria L
authors.initials: ML
authors.lastname: Azzolini
authors.forename: Fabio
authors.initials: F
authors.lastname: Caramelli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Paternoster
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pala
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Daniele
authors.initials: D
authors.lastname: Amitrano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Borghi
authors.forename: Antonella
authors.initials: A
authors.lastname: Capasso
authors.forename: Claudia
authors.initials: C
authors.lastname: Cariello
authors.forename: Anna
authors.initials: A
authors.lastname: Carpanese
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Leonardo
authors.initials: L
authors.lastname: Gottin
authors.forename: Rosetta
authors.initials: R
authors.lastname: Lobreglio
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mattioli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Monaco
authors.forename: Francesco
authors.initials: F
authors.lastname: Morgese
authors.forename: Mario
authors.initials: M
authors.lastname: Musu
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisano
authors.forename: Agostino
authors.initials: A
authors.lastname: Roasio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Russo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Slaviero
authors.forename: Nicola
authors.initials: N
authors.lastname: Villari
authors.forename: Annalisa
authors.initials: A
authors.lastname: Vittorio
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Zucchetti
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Santis
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Del Sarto
authors.forename: Antonio
authors.initials: A
authors.lastname: Corcione
authors.forename: Marco
authors.initials: M
authors.lastname: Ranieri
authors.forename: Gabriele
authors.initials: G
authors.lastname: Finco
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy*; D015897:Comorbidity; D019538:Health Care Surveys; D006439:Hemodynamics; D006801:Humans; D020407:Internet; D016343:Monitoring, Intraoperative; D019990:Perioperative Care
keywords: acute kidney failure; acute renal injury; anesthesia; consensus; consensus conference; critical care; mortality; renal failure; survival; web vote